Global Patterns of Antifungal Susceptibility Testing Data

Fungal infections cause substantial morbidity and mortality globally. The emergence of antifungal resistance for fungal diseases is a growing public health threat. Antifungal resistance in Candida auris, other Candida species, Aspergillus, and Trichophyton is increasing globally, leading to treatment failure and severe patient outcomes. Antifungal susceptibility testing (AFST) is rarely done globally for either molds or yeasts. Breakpoints and epidemiological cutoff values (ECVs) are not established for most fungal pathogens, causing difficulties in monitoring resistance patterns. We propose using the Antimicrobial Testing Leadership and Surveillance (ATLAS) antifungal dataset through the 2024 Vivli AMR Surveillance Data Challenge to explore the antifungal minimum inhibitory concentrations (MICs). For fungi that have established Clinical and Laboratory Standards Institute (CLSI) or European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints or ECVs, we will analyze the percent of non-wildtype isolates (percent of isolates above the ECV) by antifungal, year, and World Health Organization (WHO) region. For fungi without ECVs, we will determine the modal MICs by antifungal, year, and WHO region. These data can help inform public health interventions and treatment to address fungi with high modal MICs or high percentages of non-wildtype isolates in different regions. If a large percentage of isolates are non-wildtype for a certain fungus, this could indicate that the fungi may not respond to the antifungal as expected and consideration should be given to different treatment options. If a fungus has a high modal MIC for a certain antifungal in a country, this could inform policies to deter the use of that antifungal as high and potentially toxic antifungal doses may be needed to treat appropriately. AFST is a critical clinical and public health tool, and these results will highlight the need to conduct AFST globally to improve our understanding of antifungal resistance and offer better clinical treatment guidance.